- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.02 / $238.02 / $2,525.00
| Facility | | $238.02 | $238.02 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.70 / $2,222.12 / $4,362.78
| Facility | | $1,133.70 | $2,222.12 | $4,362.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.37 / $868.35 / $2,088.94
| Facility | | $556.37 | $868.35 | $2,088.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.15 / $792.43 / $1,644.84
| Facility | | $482.15 | $792.43 | $1,644.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.04 / $436.40 / $775.30
| Facility | | $259.04 | $436.40 | $775.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |